PENGARUH EMULSI LEMAK INTRAVENA DIPERKAYA MINYAK IKAN TERHADAP RESPONS INFLAMASI PADA ANAK PASCA PEMBEDAHAN GASTROINTESTINAL

Background: Surgery can increase morbidity and mortality due to the production of proinflammatory cytokines such as Interleukin (IL) -6, and tumor necrosis factor (TNF)-α. Intravenous fish oil-enriched lipid emulsion (FOLE) contains ω-3 which can reduce the release of proinflammatory cytokines. Influence of FOLE on modulation of inflammatory response compared to the standard Medium Chain Trygliceride (MCT)/Long Chain Tryglyceride (LCT) emulsion in children postgastrointestinal surgery has never been done. Objective: To explain the influence of FOLE on modulation of inflammatory response in children post-gastrointestinal surgery. Method: A randomized controlled trial was conducted in August 2018 - January 2019 at Dr. Soetomo Hospital in children post-gastrointestinal surgery due to esophageal and intestinal atresia that requires parenteral nutrition at least for 3 days. Samples were divided randomly into MCT/LCT and FOLE groups. Laboratory and cytokines parameters are examined before and 3 days after surgery. Results: Of all, 7/14 were male and 7/14 got FOLE. There were no significant differences in Hb, leukocyte, CRP, albumin, SGOT and SGPT levels in both groups. Triglyceride levels were higher in the MCT/LCT group than FOLE (P = 0.041) on day 3. The difference in IL-6 levels was significant between the two groups before (p = 0.048), 3 days after surgery (p = 0.013) and differences in 3 days (p = 0.007). TNF-α levels were not significantly different compared to MCT/LCT at day-3 post surgery (p = 0.796). Conclusion: FOLE can decrease IL-6 and reduce triglyceride levels compared to standard emulsions in postoperative children

Comparison Between Baby Led Weaning and Traditional Spoon-feeding on Iron Status and Growth in Breastfed Infants

Background: The current guideline recommends infants are initially offered smoothly pureed foods, known as the traditional method of spoon feeding. Currently, an alternative method known as ‘baby-led weaning’ (BLW) has been really popular. With BLW, infants are allowed to selffeed family foods in their whole form instead special-prepared foods. Infants following BLW may be at increased risk of faltering growth. Objective: To compare traditional and BLW methods in the risk of iron deficiency anemia (IDA) and growth faltering of breastfed infants. Methods: A cross-sectional study was undertaken in 9 – 15 months breastfed infants admitted to Bedah Hospital Surabaya from August – October 2017. Exclusion criteria were infants suffering from chronic conditions. Biochemical assessment of Haemoglobin (Hb), Serum Transferrin (ST) and Serum Ferritin (SF) was measured. Diagnosis of IDA and growth chart interpretation was made based on WHO criteria. Results: Out of all, 12/30 boys and 15/30 following BLW. Mean age was 12.6±2.14 months old. Mean Hb level, ST level and SF in BLW group was 10.9±0.55 g/dl, 11.6±7.13%, 19.1±18.40ug/dl prospectively, while in the traditional group were 12.5±0.75 g/dl, 24.6±7.92%, 57.6±18.78 ug/dl prospectively. IDA was higher in BLW group than in the traditional group. (13/15 vs 3/15, OR 26.000 95%CI 3.686-183.418, p <0.001). Underweight was higher in BLW. (13/15 vs 3/15, OR 26.000 95%CI 3.686-183.418, p <0.001). Stunted were higher in BLW (2/15 vs none, OR 1.667 95%CI 1.103-2.519. p=0.017). Conclusion: In breastfed infants, those who were following BLW are in higher risk of IDA, underweight and stunted than traditional spoonfeeding

METS-IR vs. HOMA-AD on Obese adolescents

Purpose : Obesity is associated with chronic low-grade inflammation in which is the key in the pathogenesis Insulin Resistance (IR) and Metabolic Syndrome (MetS). Homeostasis model assessment of insulin resistance (HOMA-IR) has been validated as a surrogate measure of IR. The combination of HOMA and adiponectin, known as HOMA-AD was proposed to measure IR in adults. However, study on these indicators in obese adolescents is still limited. This study aims to analyse METS-IR and HOMA-AD to determine MetS and IR in obese adolescents. Methods : A cross-sectional study was conducted on obese adolescents who looked healthy from secondary schools in Surabaya and Sidoarjo, East Java, aged 12-18 years. Subjects were selected randomly and grouped into 2, namely MetS and non-MetS based on IDF 2000. Anthropometric examination and blood measurements, such as fasting blood glucose levels, lipid profiles, insulin, and adiponectin level were carried out according to standards. HOMA-IR, HOMA-AD, AND METS-IR were calculated using formula. Spearman’s Rho correlation were conducted between assessment tools (METS-IR and HOMA-AD) to identify the correlation with MetS component (lipid profile, FBG, and blood pressures). A receiving operation curve (ROC) performed to find area under curve (AUC) and cut-off points based on the biggest Youden index. Result : A total of 250 subjects were enrolled the study, and found 103 subjects had MetS. METS-IR correlates with all lipid profile and blood pressures (p < 0.05). While HOMA-AD correlated with TG (r = 0.356, p = 0.000), systolic-BP (r = 0.188, p = 0.003), and HDL-c levels (r=-0.249, p = 0.000). Cut-off point for METS-IR to determines MetS in obese adolescents was ≥ 46.53 (sensitivity of 64.24% and specificity of 75.76%), while HOMA-AD was ≥ 0.43 (sensitivity of 71.52% and specificity of 59.60%). Cut-off point for METS-IR index to determines IR was ≥ 52.01 (sensitivity of 83.44% and specificity of 44.44%). Cut-off point for HOMA-AD to determine IR was ≥ 0.37 (sensitivity of 74.17% and specificity of 84.85%). Conclusion : METS-IR is better surrogate to determine MetS with cut-off point of ≥ 46.53, while HOMA-AD is better to determine IR with cut-off point ≥ 0.37 in obese adolescents

The association of adiponectin serum level and body mass index among Javanese obese adolescents

Introduction : The adiponectin level should decrease in obese people, however, many previous studies’ results about its role in obesity still remain controversies.The present study aimed to evaluate the profile of adiponectin serum level among obese adolescents in Javanese population and its correlation with body mass index (BMI)Methods : A cross-sectional study involving obese adolescents aged 13-18 years old from some schools was conducted from May to September 2020. The subject were determined by using a total population sampling method that met inclusion and exclusion criteria. Anthropometries were measured to count BMI and determine obesity according to CDC 2000. The adiponectin serum level was examined by ELISA from blood samples. Data were analyzed using Mann-Whitney Test and Spearmann correlation, with a significance value at p < 0.05.Results: There were 240 obese adolescents involved (52.1% boys) in the present study. There were significant differences in the mean of body-weight and body-height according to gender (p<0.05), however, there was no significant difference in BMI based on genders. The median of adiponectin serum level was 13.9 (1.5-46.6) μg/ml, which had no correlation with BMI (p=0.98; r=0.002).Conclusion: The adiponectin serum level had no significant correlation to body mass index. More studies are suggested to find out several factors that might influence the adiponectin serum level in Javanese populatio

DEMOGRAPHIC CHARACTERISTICS AND BODY MASS INDEX IN OBESE ADOLESCENTS

Background: The prevalence of adolescent obesity is increasing in Indonesia. Obesity can reduce the quality of life, especially as most obese adolescents remain obese after they become adult. In obese adolescents, the higher their IMT (intima-media thickness), the higher the risk of cardiovascular disease in adulthood. Purpose: The aim of this study is to analyse the correlation of demographic characteristics with BMI (body mass index) in adolescents with obesity. Methods: This study is a cross-sectional study on adolescents with obesity conducted in the Paediatric Nutrition and Metabolic Disease Clinic of Dr Soetomo General Hospital, Surabaya. The data on demographic characteristics, such as gender, number of siblings, paternal education, maternal education, and maternal occupation, were collected using the interview method. Data on anthropometry were collected to calculate BMI. Obesity is established if it is higher than the 95th percentile, based on CDC percentile of BMI, according to age and sex. Data were analysed using multiple regression. Results: A total of 59 obese adolescents, between 13 and 16 years old, were involved. As many as 49.20% of respondents had one sibling. As many as 52.50% of respondents had a father with a high school education and 44.10% of respondents had mothers with a high school education; 61% of respondents had working mothers. There was no correlation between BMI and demographic characteristics (p> 0.05), except for number of siblings (p = 0.02). Conclusion: In this study, the number of siblings was correlated with BMI. A study with a greater number of obese adolescents and with adolescents who have normal nutritional status is needed to fully assess the influence of demographic characteristics on BMI in obese adolescents

PLA2G6-Associated Neurodegeneration: A Rare Case Report of Neurodegeneration with Brain Iron Accumulation in Children

Abstract This report aimed to describe and review the clinical features, neuroimaging findings, and PLA2G6 mutations identified in a 34-month-old girl with regression of developmental milestones. A 34 months old girl came to Dr.Soetomo Hospital’s outpatient clinic, Surabaya, with a developmental regression for six months, and got worse until she could not do any activity and was followed by recurrent seizures. She had a sibling who had similar problems and symptoms and then died at five years of age. The head MRI revealed brain atrophy, the possibility of an early sign of metabolic disorder, and a white matter lesion at the globuspallidus bilateral that supports the encephalopathy metabolic view. The genetic test revealed a positive homozygous such as a pathogenic variant in the PLA2G6 gene, which confirmed the diagnosis. PLA2G6-Associated with Neurodegeneration (PLAN) should be considered as a diagnosis in children with developmental regression

SLEEP DURATION AND METABOLIC SYNDROM IN OBESE ADOLESCENTS

ABSTRACTShorter sleep duration is a risk factor for obesity and metabolic syndrome. Previous studies conducted on different races showed inconsistent results. The purpose of this study was to analyze the differences in sleep duration in obese adolescents who suffer from metabolic syndrome compared with obese adolescents who do not suffer from metabolic syndrome. A cross sectional study was carried out on 59 obese adolescents who visited the Pediatric Nutrition and Metabolic Disease Clinic in Dr. Soetomo General Academic Hospital, Surabaya. Subjects were selected using total sampling techniques who met the inclusion and exclusion criteria in August-November 2018. Anthropometry (weight, height and waist circumference), blood pressure, and blood tests (HDL cholesterol levels, triglycerides, and fasting blood glucose levels) were held to determine obesity according to CDC 2000 and metabolic syndrome according to International Diabetes Federation. The difference in sleep duration in obese adolescents suffering from metabolic syndrome and without metabolic syndrome analyzed using Chi square test. A total of 27 subjects (45.8%) suffered from metabolic syndrome. Most obese adolescents (57,6%) have suffi cient sleep duration (≥ 8 hours/day). There was no sleep duration differences in obese adolescents suffering and not suffering from metabolic syndrome (p> 0.05)

Association between anthropometric parameters and carotid intima-media thickness in obese adolescents

Abstract Introduction: Prevalence of obesity among adolescents is increasing in developing countries. Inflammation in obesity causes atherosclerosis which could develop into cardiovascular disease. Carotid intima-media thickness (CIMT) is a non-invasive subclinical marker of atherosclerosis. Determining the association between body size and atherosclerosis may allow early detection of atherosclerosis risk. Objectives: To assess the association between anthropometric parameters and CIMT in obese adolescents. Method: A cross sectional study was conducted on adolescents with central obesity who visited the paediatric clinic of Dr. Soetomo General Hospital, Surabaya, Indonesia. Eating habits were obtained through food recall. Weight, height, waist circumference and thigh circumference were measured for calculation of body mass index (BMI) and waist to hip ratio (WHR). Obesity was defined as BMI >P95 according to age and sex. CIMT was obtained through B mode ultrasonography on the neck. Analysis was done using Spearman rho' to analyse association between BMI, waist circumference, WHR and CIMT. Results: There were 59 obese adolescents, comprising 32 (54.2%) males and 27 (45.8%) females. BMI, waist circumference and WHR were not significantly associated with CIMT in obese adolescents (p>0.05). Conclusions: In this study, BMI, waist circumference and WHR were not significantly associated with CIMT in obese adolescent

Effect of Different Complementary Feeding on Iron Deficiency Anemia and Growth In Breastfed Infants: Home-Made vs Commercial

After approximately 6 months of age, term breastfed infants are increasingly depend on other sources of iron to avoid iron deficiency anemia, due to the depletion of the low concentration of iron in human milk. The appropriate complementary feeding must include a balance composition of foods containing an adequate amount of macro- and micronutrients to avoid iron deficiency anemia. This study aimed to compare the risk of iron deficiency and growth in breastfeed infants receiving commercial fortified complementary foods or home-made. A cross-sectional study was held on April-June 2016 to evaluate infants aged 6-24 months with breast feeding intake for 6 month of life. Complementary feeding practices were determined by questionnaire; an unquantified food frequency and feeding practices questionnaire was used to determine usual food intake. Biochemical assessment of haemoglobin (Hb), serum ferritin (SF) and serum iron (SI) level were measured. Anthropometric were assessed using WHO Child Growth Standard 2005. Statistical analysis used were Chi-square Test. Thirty eight infants were enrolled, mean age of 16.2 (SD 10.5) months. 17 infants consumed commercial complementary foods and 21 infants use home-made. Infants with home-made had lower Hb level, SF and SI than those receiving commercial complementary food, and had higher risk of underweight, stunted and wasted. Infants with home-made complementary food had lower haemoglobin, serum feritin and serum iron levels than those in fortified complementary food CF; and a higher risk of stunted and wasted than children with commercial fortified CF

Comparison study between commercial and modified grains mix WHO formula F-100 to weight, serum amylase and lipase in children aged 1-3 years

Introduction: children with cow´s milk allergy require special formulas contain ingredients that doesn´t cause allergies or intolerances. Ready-to-use modified grains mix formula at Dr. Soetomo hospital based on modified gain mix WHO formula F-100, while commercial grain mix products fortified with micronutrients and amylase enzyme can be used as alternative if it is not available in the hospital. This study aims to compare the differences of weight gain, amylase and lipase enzyme levels between commercial (CGMF) and modified grain mix WHO formula F-100 (CGMF) in children aged 1-3 years. Methods: the study were quasi-experimental trials randomized controlled design, subjects were children aged 1-3 years who drink soy formula with cow´s milk allergy at outpatient clinic Dr. Soetomo hospital divided into commercial grain mix (CGMF) and modified grain mix WHO formula F-100 (MGMFW) groups. The evaluation of weight gain, levels of serum amylase and lipase were done before and after of formula consumption. Statistical analysis incuding Chi-square Test, Independent sample T-Test, Paired sample T-Test, and Anacova using SPSS ver. 17.0 (IBM, US). Results: a total of 17 subjects in CGMF and 16 subjects in MGMFW groups. There are significant difference in body weight gain, serum amylase and lipase level before and after the administration of CGMF and MGMFW (p0,005). Conclusion: commercial formula is equivalent to modified grains mix in weight gain, serum amylase and lipase levels so that it can be used as an alternative formula in the nutritional management of cow´s milk allergy in children aged 1-3 years old to ensure optimal growth